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Correspondence |
* Aligarh, India
Charlotte, North Carolina
To the Editor:
One of the most promising non-pharmacologic techniques to prevent postoperative nausea and vomiting (PONV) has been the use of transcutaneous electrical nerve stimulation of the P6 point.1–3
The purpose of the present study was to determine whether stimulation of the P6 point with train-of-four (TOF) mode of the conventional peripheral nerve stimulator (PNS), from induction of anesthesia until the reversal of residual neuromuscular blockade, is efficacious in controlling PONV following laparoscopic procedures without compromising monitoring of neuromuscular block.
Following Board-of-Studies permission and written consent of the patient, 42 ASA I and II female patients undergoing elective laparoscopic procedures lasting 60 to 90 min were selected without considering phase of menstrual cycle. The patients were randomly divided into two groups of 21 each. In patients of Group C [control: 34.2 ± 10.5 yr; 54.4 ± 6.0 kg], TOF monitoring was achieved by the conventional placement of the electrode of the PNS (TOF–Watch, Organon Ltd., Dublin, Ireland) along the ulnar nerve. In patients of Group S (study: 32.7 ± 11.7 yr; 54.3 ± 4.6 kg), the cathode of the PNS was placed at the P6 point,4 while the anode was placed 5 cm apart, more proximally (Figure
). This stimulates the median nerve, a site recommended for TOF monitoring.5
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A paired t test was used to compare the incidence of PONV. P < 0.05 was considered significant.
The incidence of PONV in the control group was 52.4% (11/21), which was greater than the 28.6% (6/21) incidence observed in the study group. All 11 patients of the control group except one had PONV within the first six postoperative hours. On the contrary, all six patients of the study group had a first episode of PONV after the first six hours. Furthermore, study group patients needed only one (mean) dose of metoclopramide to control PONV over the first 24 hr as compared to 2.4 doses in the control group. The probable mechanism of action of P6 stimulation in controlling PONV is due to the release of neurotransmitters in the brain.2,3
In conclusion, our study suggests that P6 stimulation using PNS not only reduces the incidence of PONV following laparoscopic surgery, but also reduces the antiemetic requirement needed to control PONV without affecting TOF monitoring of the neuromuscular blockade: a two-in-one use of the PNS.
References
1 Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999; 88: 1362–9.
2 Fassoulaki A, Papilas K, Sarantopoulos C, Zotou M. Transcutaneous electrical nerve stimulation reduces the incidence of vomiting after hysterectomy. Anesth Analg 1993; 76: 1012–4.
3 Stein DJ, Birnbach DJ, Danzer BI, Kuroda MM, Grunebaum A, Thys DM. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesth Analg 1997; 84: 342–5.[Abstract]
4 Rowbotham DJ. Nausea, vomiting and their treatment. In: Aitkenhead AR, Rowbotham DJ, Smith G (Eds). Textbook of Anaesthesia, 4th ed. Edinburgh: Churchill Livingstone; 2001: 244–9.
5 Dorsch JA, Dorsch SE. Neuromuscular transmission monitoring. In: Dorsch JA, Dorsch SE (Eds). Understanding Anesthesia Equipment, 4th ed. Baltimore: Williams & Wilkins; 1998: 849–92.
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